Enhanced Care Management (ECM) is a Medi-Cal benefit designed to support individuals with complex health and social needs by providing them with a dedicated Lead Care Manager who coordinates their healthcare and related services. This program aims to improve health outcomes, reduce hospital readmissions, and enhance patient satisfaction through a whole-person, community-based approach.
Who is eligible?
- Medi-Cal members with complex needs, including those experiencing or at risk of homelessness, those at risk for avoidable hospitalizations, and individuals with serious mental health or substance use disorders.
- Pregnant and postpartum individuals are also a specific focus.
- Children and youth involved in child welfare (foster care) are also eligible.
What services are provided?
- Dedicated Lead Care Manager:
- Members are assigned a single care manager who acts as a primary point of contact and helps coordinate their care.
- Comprehensive Care Management:
- The care manager helps individuals navigate and access healthcare services, including physical, behavioral, and dental care, as well as social services like housing support and transportation.
- Community-Based Approach:
- Services are often delivered in the community, where members live, work, or seek care.
- In-person interactions:
- ECM providers aim to meet with members in person to assess their needs and develop individualized care plans.
- Support for social determinants of health:
- ECM addresses factors beyond medical care, such as housing instability, food insecurity, and transportation challenges, that can impact health.
- Collaboration with other services:
- ECM providers work with other community-based organizations and service providers to ensure members receive a coordinated and comprehensive set of supports.
Who is on your care team?
- Nurse Care Manager
- Behavioral Health Care Manager
- Care Coordinator
- Community Health Worker
Our ECM Populations of Focus
Child: And youth involved involved in child welfare or foster care
Child: Children and youth transitioning from a youth correctional facility
Child: Children and youth Enrolled in CCS or CCS WCM with additional needs
Child: Homeless children and youth
Child: Avoidable hospital Or ED utilization
Child: Serious mental health and or SUD needs
Adults: Homeless Families
